Healthcare Provider Details

I. General information

NPI: 1841630589
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST STE 125
PLAINFIELD IL
60585-9507
US

IV. Provider business mailing address

27555 DIEHL RD ENTRANCE B
WARRENVILLE IL
60555-3849
US

V. Phone/Fax

Practice location:
  • Phone: 630-961-9485
  • Fax:
Mailing address:
  • Phone: 630-646-3950
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BILL KOTTMANN
Title or Position: PRESIDENT
Credential:
Phone: 630-646-3950